Explaining Stroke

Introduction

Explaining Stroke is a practical step-by-step booklet

that explains how a stroke happens, different types of
stroke and how to prevent a stroke. Many people think a
stroke happens in the heart, but it happens in the brain.
Read on to learn more.

Table of Contents
Introduction................................................................2
What is a Stroke?........................................................3
Blood Flow in Normal and Blocked Arteries........... 4
Blood Flow to the Brain .......................................... 5
Arteriography.......................................................... 6
Ischemic Stroke...........................................................7
Transient Ischemic Attack (TIA)..................................8
Hemorrhagic Stroke....................................................9
Intracerebral Hemorrhage.....................................10
Subarachnoid Hemorrhage................................... 11
Aneurysm...............................................................12
How a Stroke Affects You.......................................... 13
Moving and Sensing Things...................................14
Some Effects of Stroke...........................................15
Prevent Another Stroke............................................. 16
Carotid Artery Disease ............................................. 17
Stroke Symptoms...................................................... 18

2
What is a Stroke?

Middle
Cerebral
Artery
Anterior Posterior
Cerebral Cerebral
Artery Artery

Opthalmic Basilar Artery

Artery

Internal
Carotid
Vertebral Artery
Artery

Blood vessels that carry blood to the brain from the

heart are called arteries. The brain needs a constant
supply of blood, which carries the oxygen and nutrients
it needs to function. Specific arteries supply blood to
specific areas of the brain. A stroke occurs when one of
these arteries to the brain is either blocked or bursts.
As a result, part of the brain does not get the blood it
needs, so it starts to die.

3
 Blood Flow in Normal
and Blocked Arteries
NORMAL ARTERY
Blood flows easily through a clear artery.

BLOCKAGE
An artery can become blocked by plaque (a fatty
substance in the wall of the artery) or a blood clot,
which reduces blood flow to the brain and causes a
stroke. This picture shows atherosclerosis, a hardening
of the arteries. Atherosclerosis is caused partly by
cholesterol or plaque buildup.
Atherosclerosis

Clot

CLOT DISSOLVES
A transient ischemic attack or TIA has the same signs and
symptoms of a stroke, but they only last a short time.
The plaque or blood clot breaks up and blood flow is
restored to the brain and there is no permanent damage.
A TIA is serious and needs to be evaluated by a health
care provider.

4
Blood Flow to the Brain

Area at
Risk

Lodged
Blood Clot

This picture shows a blood clot blocking an artery in

the brain. Without enough blood flow, brain cells
begin to die.

5
 Arteriography

The doctor will take an x-ray picture of your brain, called

an arteriogram or angiogram. A dye is injected into the
blood vessels that lead to the brain. The dye will show up
on the x-ray and help locate blocked, narrowed or
damaged blood vessels in the brain.

6
 Ischemic Stroke

Blood
Clot

Cardiovascular System

Ischemic Stroke
Ischemic stroke is the most common type of stroke.
An ischemic stroke happens when an artery in the brain
is blocked. There are two types of ischemic stroke:

Embolic Stroke: In an embolic stroke, a blood clot or

plaque fragment forms, usually in the heart or the
large arteries leading to the brain, and then moves
through the arteries to the brain. In the brain, the
clot blocks a blood vessel and leads to a stroke.
Thrombotic Stroke: A thrombotic stroke is a blood
clot that forms inside an artery that supplies blood
to the brain. The clot interrupts blood flow and
causes a stroke.

7
 Transient Ischemic Attack (TIA)

Interior
Cerebral
Artery

Middle
Cerebral
Artery

Blockage
Internal
Carotid Artery

If an artery in the brain or one that goes to the brain is

blocked for a short time, blood flow slows down or stops.
This can cause a transient ischemic attack, sometimes
called a mini-stroke. A TIA’s major symptoms include
sudden:
• Numbness, weakness or paralysis of the face, arm or leg,
usually on one side of the body
• Loss of vision in one or both eyes or double vision
• Trouble speaking or difficulty understanding others
• Loss of balance or coordination
• Severe headache with no known cause

When a TIA happens, the artery either becomes

unblocked after a short time or a new path opens up and
blood flow is normal. Symptoms last for a short time and
then disappear. A TIA is a serious warning that you might
have a stroke.
8
 Hemorrhagic Stroke

Cerebral
Hemorrhage

A hemorrhagic stroke happens when a blood vessel in

the brain bursts and spills blood into or around the brain.
High blood pressure and aneurysms (see page 12) can
make blood vessels weak enough to burst.

There are different types of hemorrhagic stroke, including

intracerebral hemorrhage and subarachnoid
hemorrhage.

9
 Intracerebral Hemorrhage

Cerebral
Hemorrhage

Middle Internal
Cerebral Carotid
Artery Artery

Normal Vessel Bulging Vessel Burst Vessel

One kind of hemorrhagic stroke is called an intracerebral

hemorrhage. This kind of stroke is caused when a burst
blood vessel bleeds into brain tissue. The bleeding causes
brain cells to die and the part of the brain that is affected
stops working correctly. High blood pressure, also called
hypertension, is the most common cause of this type
of stroke.

10
 Subarachnoid Hemorrhage

Subarachnoid
Space

Middle
Cerebral
Artery

Saccular
Aneurysm Subarachnoid Space
(in Blue) Between Skull
and Brain
(enlarged view)

Another kind of hemorrhagic stroke is called a

subarachnoid hemorrhage. In this type of stroke, a blood
vessel bursts near the surface of the brain and blood
leaks into the space between the brain and the skull (the
subarachnoid space). Blood that collects in this space
puts pressure on brain tissue and causes blood vessels to
spasm. This type of stroke can be caused by different
things but is usually caused by a burst aneurysm.

11
 Aneurysm

Middle
Cerebral
Artery
Aneurysm

Saccular Aneurysm Ruptured Saccular

Aneurysm

An aneurysm is a weak spot on the wall of an artery that

bulges out into a thin bubble. As it gets bigger, the wall
may weaken and burst. If it bursts, blood leaks inside or
around the brain.

12
How a Stroke Affects You

LEFT HEMISPHERE RIGHT HEMISPHERE

Spoken
Language Music

Number Spatial
Skills Orientation

Written Art
Language Awareness

Reasoning Creativity

Scientific
Functions Insight

The Sides of the Brain

A stroke on the left side of the brain affects the right side
of the body and you may experience some of the
following:
• Speech and language problems
• Inability to read, write and learn new information
• Impaired ability to do math or to organize, reason and
analyze things

A stroke on the right side of the brain affects the left side
of the body and you may experience some of following:
• Problems with depth perception or directions, such as up
or down, and front and back
• Inability to be creative, such as painting a picture, or to
appreciate art and music
• Failure to recognize the emotion in someone’s voice

13
 Moving and Sensing Things

Hand Hip Leg

Trunk Trunk
Arm
Arm
Hand
Fingers
Face
Speech Face Language
Hearing
Smell Vision
Emotions

Posture
Balance
Coordination

The human brain has different areas that control how the
body moves and feels. When a stroke damages a certain
part of the brain, that part may not work as well as it did
before. This can cause problems with walking, speaking,
seeing or feeling. There may be challenges with basic
self-care such as bathing or dressing, eating, swallowing,
memory, emotions and understanding surroundings that
should be familiar.

14
Some Effects of Stroke

After a stroke, you may have emotional and physical

changes. Depending on the amount of brain damaged
and the part of your brain that was affected, you might
have problems with:

seeing sleeping

controlling
having seizures your bladder
or bowels

moving parts
pain
of your body

fatigue thinking

memory depression

15
 Prevent Another Stroke

If you’ve had a stroke, you’re at risk of having another

one. Do these things to prevent another stroke.

If you have high blood pressure, lower it. Measurement of

130/80 mm Hg and above is considered high blood pressure,
work with your health care provider to manage it.

Find out if you have atrial fibrillation (AFib). AFib is a

quivering or irregular heartbeat that can lead to blood clots
and cause a stroke. Your health care provider can tell you if
you have AFib and help you manage it.

If you smoke, stop. Smoking doubles the risk for stroke.

If you drink alcohol, do so in moderation. Heavy drinking can

increase your risk for stroke.

Lower your cholesterol (the fat-like substance in your blood).

Studies suggest ideal total cholesterol levels at about
150 mg/dL, which equals about 100 mg/dL for low-density
lipoprotein cholesterol (LDL-C). Lower cholesterol levels are
linked with lower rates of heart disease and stroke.

If you have diabetes, follow your health care provider’s advice

carefully to get your blood sugar level under control. Having
diabetes puts you at an increased risk for stroke. Talk to your
health care provider about a diet that will help you manage
your diabetes, such as limiting foods high in added sugars.

Exercise daily. Even a little exercise—a brisk walk, swim or

yard work—can improve your health and may reduce your
stroke risk. Check with your health care provider before
starting a new exercise regimen.

Cut down on sodium and saturated and trans fat. By reducing

these, you can lower your risk for stroke, high blood pressure
and heart disease.
16
Carotid Artery Disease

Carotid artery disease, also called carotid artery

stenosis, occurs when fatty deposits (plaques) clog the
blood vessels that deliver blood to your brain and head.
This condition develops slowly and results in a narrowing
of the arteries, increasing your risk of stroke. There are
often no symptoms and the first sign may be a stroke or
TIA. Regular checkups are important, and your health
care provider can listen to the arteries in your neck with
a stethoscope for abnormal sounds. Other tests, such as
carotid ultrasound, are available and can be
recommended by your health care provider.

Cerebral angiography: Uses a contrast dye which is

injected into the carotid arteries and lets the health care
provider see blood flow through the carotid arteries in
real time.

To effectively treat carotid artery disease, health care

providers recommend to:

• Follow recommended lifestyle habits (see page 16)

• Take medications as prescribed

• Have a medical procedure to improve blood flow:

Carotid endarterectomy (CEA): During this surgery, the fatty

deposits (plaques) narrowing the arteries in your neck are
removed.

Carotid artery stenting (CAS): This newer treatment involves

the placement of a permanent stent (small, expandable tube)
in the artery that holds the artery open.

17
 Stroke Symptoms

Beyond F.A.S.T., other symptoms you should know

include:
• Sudden numbness or weakness of face, arm or leg,
especially on one side of the body

• Sudden confusion, trouble speaking or understanding

speech

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness or loss of balance or

coordination

• Sudden severe headache with no known cause

NOTE THE TIME WHEN ANY SYMPTOMS FIRST APPEAR.

Medical options exist that may reduce the long-term
effects of stroke if administered soon after the
onset of stroke.

If you have any of these symptoms or see

someone else having them, call 911
immediately! Fast treatment at the
hospital can have better results.

See page 19 for a test you can use to tell if someone might be
having a stroke.

18
 SPOT A STROKE™

FACE
Drooping

ARM
Weakness

SPEECH
Difficulty

TIME
to Call 911

Learn about more signs of stroke at

stroke.org
19
 For stroke information,
call the American Stroke Association
at 1-888-4-STROKE (1-888-478-7653)
or visit stroke.org.

For information on life after stroke,

call and ask for the Stroke Family Warm Line.

For heart- or risk-related information,

call the American Heart Association at
1-800-AHA-USA1 (1-800-242-8721)
or visit us online at heart.org.

© Copyright 2020 American Heart

Association, Inc., a 501(c)(3) not-for-profit. All
rights reserved. American Stroke Association is
a registered trademark of the AHA.
Unauthorized use prohibited.

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